HumanaCommercial Clinical Policy

Humana Home Births and Birth Doulas Form

Effective Date

04/27/2023

Last Reviewed

NA

Original Document

  Reference



Description

A home birth is the planned delivery of a baby that occurs outside of a hospital or certified birthing center and in an individual’s home. The planned delivery of a baby should always be attended by a physician or certified midwife.

An underwater birth is the delivery of a newborn while the mother is immersed in a pool or tub of water. Hydrotherapy, the medical use of water for pain relief and/or treatment, is sometimes utilized to alleviate discomfort associated with labor. Some hospitals and certified birthing centers offer hydrotherapy during the first stage of labor for that purpose; however, the practice of immersion in the second stage of labor (underwater delivery) is not advised.1,2,6

Birth doulas are trained, nonclinical professionals that can provide advocacy, comfort or support for laboring patients. Doulas should not replace medical staff,

Home Births and Birth Doulas

Effective Date: 04/27/2023
Revision Date: 04/27/2023
Review Date: 04/27/2023

Policy Number: HUM-0556-006

Page: 2 of 6

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

perform clinical/medical tasks or intervene in clinical care, but can purportedly facilitate communication and help an individual gain a better understanding of the labor process, medical procedures, options for coping with pain and possible complications of labor or birth.14

Coverage Determination

Any state mandates for home births, underwater births and birth doulas take precedence over this medical coverage policy.

Humana members may NOT be eligible under the Plan for home births, including underwater births. These are associated with increased risk1, 2, 3, 5, 6 and considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Note: The criteria for births in the home setting are not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Humana members may NOT be eligible under the Plan for birth doulas in any setting. These are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Additional Information

Additional information about home births and underwater births may be found from the following websites:

  • American Academy of Pediatrics
  • American College of Obstetricians and Gynecologists
  • National Library of Medicine

Medical Alternatives

Alternatives to home births include, but may not be limited to:

  • Certified birthing centers
  • Hospital births

Page: 3 of 6

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Alternatives to underwater births include, but may not be limited to:

  • Traditional birthing positions

Alternatives to birth doulas include, but may not be limited to:

  • Certified nurse midwives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Humana may offer a management program for this condition. The member may call the number on their identification card to ask about our programs to help manage their care.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes.

Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

Home Births and Birth Doulas
Effective Date: 04/27/2023
Revision Date: 04/27/2023
Review Date: 04/27/2023

Policy Number: HUM-0556-006

Page: 4 of 6

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Home Births and Birth Doulas
Effective Date: 04/27/2023
Revision Date: 04/27/2023
Review Date: 04/27/2023

Policy Number: HUM-0556-006

Page: 5 of 6

References

  • American Academy of Pediatrics (AAP). Clinical Report. Immersion in water during labor and delivery. https://www.aap.org. Published April 2014. Accessed April 10, 2023.
  • American Academy of Pediatrics (AAP). Clinical Report. Risks of infectious diseases in newborns exposed to alternative perinatal practices. https://www.aap.org. Published February 2022. Accessed April 10, 2023.
  • American Academy of Pediatrics (AAP). Policy Statement. Planned home birth. https://www.aap.org. Published May 2013. Updated 2017. Accessed April 10, 2023.

Humana's documents are updated regularly online.

When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • American Academy of Pediatrics (AAP). Policy Statement. Providing care for infants born at home. https://www.aap.org. Published May 2020. Accessed April 10, 2023.
  • American College of Obstetrics and Gynecologists (ACOG). Committee Opinion. https://www.acog.org. Published February 2019. Updated 2019. Accessed April 13, 2023.
  • American College of Obstetricians and Gynecologists (ACOG). Committee Opinion. Immersion in water during labor and delivery. https://www.acog.org. Published November 2016. Updated April 2021. Accessed April 10, 2023.
  • American College of Obstetricians and Gynecologists (ACOG). Committee Opinion. Planned home birth. https://www.acog.org. Published April 2017. Updated 2020. Accessed April 10, 2023.
  • Centers for Medicare & Medicaid Services (CMS). Medicare Benefit Policy Manual. Covered medical and other health services. https://www.cms.gov. Published March 12, 2021. Updated April 12, 2021. Accessed April 6, 2023.
  • ClinicalKey. Grünebaum A, Bornstein E, Katz A, Chervenak FA. An immutable truth: planned home births in the United States result in avoidable adverse neonatal outcomes. Am J Obstet Gynecol. 2022:226(1):138-140. https://www.clinicalkey.com. Accessed April 6, 2023.
  • ClinicalKey. Grünebaum A, Bornstein E, McLeod-Sordjan R, et al. The impact of birth settings on pregnancy outcomes in the United States. Am J Obstet Gynecol. 2023. https://www.clinicalkey.com. Accessed April 6, 2023.
  • ClinicalKey. Grünebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA. Perinatal risks of planned home births in the United States. Am J Obstet Gynecol. 2015;212(350):e1-6. https://www.clinicalkey.com. Accessed April 6, 2023.
  • Grünebaum A, McCullough LB, Arabin B, Dudenhausen J, Orosz B, Chervenak FA. Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States. J Perinatol. 2017;45(3):349-357.
  • UpToDate, Inc. Birth centers. https://www.uptodate.com. Updated March 2023. Accessed April 6, 2023.
  • UpToDate, Inc. Continuous labor support by a doula. https://www.uptodate.com. Updated March 2023. Accessed April 13, 2023.
  • UpToDate, Inc. Nonpharmacologic approaches to management of labor pain. https://www.uptodate.com. Updated March 2023. Accessed April 6, 2023.
  • UpToDate, Inc. Overview of the routine management of the health newborn infant. https://www.uptodate.com. Updated March 16, 2023. Accessed April 6, 2023.
  • UpToDate, Inc. Planned home birth. https://www.uptodate.com. Updated March 9, 2023. Accessed April 6, 2023.
Home Births and Birth Doulas
Effective Date: 04/27/2023
Revision Date: 04/27/2023
Review Date: 04/27/2023

Policy Number: HUM-0556-006

Page: 6 of 6

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.